Form R - Mt. Gilead Income Tax Return - Ohio Income Tax Department (Page 2 of 3) in pdf

Form R - Mt. Gilead Income Tax Return - Ohio Income Tax Department Page 2

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VILLAGE OF MT, GILEAD

lNCOl,lE TAX DEPARTMENT

72 W. I-ligh Slre€l

lMt. Gllead, Ohio 43038

IF MOVEO DURiNG TF]EYEAR.

THIS MUST 3E COMPLETEO:

MOVED N -

MOVED OUT

FOR OFFICE USE ONLY

INITIAL

MT, GILEAD INCOME TAX RETURN

FILING FEQUIFEO EVEN IF NO TAX PUE

FILE ON OF BEFOFE APFILl5

PAYABLE TO: VILLAGE OF MT. OILEAD

casN $ _

ct-tEcK $-

cftEcK

NUMBER -

NOTE] FagE 2 SoorlonAmustbo oomplotsd iryou havo iaxabl€ rontrl proporly orbudnFs Inoom..

| . WAGES, SALARIqS, TIPE AND OTll ER EMPLOYEE

COJVIPENSAT

ON (llSE BOX 5 OR 16, WHICHEVER

lS HIGNER ON W-2S). .. ., ,

. .. . 9-

(ATTACI,I AI.L W.2'9 ON SACK)

TAXFAYER'S

NAME, ADDFESS

B TOTAL AMOUNT DUE (LINE 6 PLUA64)

7. OVERPAYMEI\II

IO BE FEIUIIDED 3

3 . r ^ x A B - E . r c o M E L l \ E ' , P L U S L T \ E

2 . . . . . . . . . . . . .

4. t!lT. G -EAD TA,\ l%Or LINE J

A T ' \ W T H H E L O

B Y E M P L O Y E R

F O R V L L L A G E

O F M I G I L E A D .

, , , . . . . . . . . . " ' , ' ' 6

B . C U R R E N T Y E A R

E S T I M A ' E O T l " \

P A L D T O

T H E V L L A G E O F [ I T . G I L E O . . , .

, . . . . . . . . . . . . . , . , . , . . . , . . . . . . . . . . . . .

A FALLI]RE

TO FILEAND PAYRETURN

AYAPTiIL 16TH WILL BEAS€ESSEDAPENALTY

OF $25,OOAND

INTERES'I--

TOTAL

r_---_____'-:--:.1

. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. .

! t

. I

TO II]EXI YEANS BTIMATE

(AMO0lltoF LE36IHAN $10,00 wlLL Nol BE cOLLECIED On nEUNrtD OR CARnllD

DECLAFATION OF ESTIMATED TAX FOR YEAR

(PLEASE PAYYOUR 1ST ESTIMATE WITH THIS RETURN)

TOIAL |iJCOME SUSJECI iO IAX '

MI]LTIPLY BY IAX BATE OF 1'6 'ON GROSS TAX OF .,

$ .-

r --------:::--

1I.

AMOUNT FAID MIIJIi THIS D

1?. toTA-lHl3 paYMENT iLINE 68 PLUS tll',lE 111

....

ICEFTIFYTHAT IHAVE EXAM]NEO TI-IIS RETURN (LNCLUDINO

ACCOMPANY

NG SCHEO]JLES

AND STATEMENTS)

AND'IO THE BEST OF MY KNOWLEDGE

ANO

bEiieilrtsraue, connecr em cor,,lprere.

r"- Faepeaiiii e iensoN oixenrrar roxee"EtlHE DECLARATIoN

ls BASED

oN ALLINFoFMATIoN

w +.r. pncpanra r qs r'1" <ttowLEDGE V^Y wE Dlscrss rr s Pl I UFN wrTH ' ouF PFFDTnFq L-l\ es Ll No

grs^'Ill6fl;dn

PG@'ins ir oho.Ii4 rdp&vsr

Form R - Mt. Gilead Income Tax Return - Ohio Income Tax Department Page 2

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